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General NPI Number Information
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NPI Number | 1669993283
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Entity Type | Organization
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Legal Business Name | RENEWED CLARITY COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 07/05/2017
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Provider Practice Location Address
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Address Line | 2663 44TH ST SW STE 106
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City | WYOMING
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State | MI
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Zip | 49519-4189
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Country | US
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Telephone | 616-822-5518
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 EMERALD WOODS DR SE
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City | BYRON CENTER
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State | MI
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Zip | 49315-8977
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Country | US
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Telephone | 616-822-5518
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. MELISSA LYNN VANDER KOOI
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Credential | LPC
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Telephone | 616-822-5518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6401007890
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License Number State | MI
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